Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 20 Endocrine Disorders

20-2 Objectives

Glucose –Sugar –Basic fuel for body cells –Level of sugar in the blood must remain fairly constant 20-3

Glucose Regulation 20-4

Pancreatic Cell Function Pancreatic Cells Hormone Released Hormone Function AlphaGlucagonStimulates cells in the liver to break down stores of glycogen into glucose; increases blood sugar BetaInsulinHelps glucose enter body cells to be used for energy; decreases blood sugar DeltaSomatostatinInhibits release of insulin and glucagon 20-5

Insulin –Helps transport glucose from the blood into cells where glucose is stored or used as fuel 20-6

Types of Diabetes Mellitus Diabetes Type Other NamesPossible Causes Type IInsulin-dependent diabetes mellitus (IDDM) Juvenile diabetes Usually unknown Viral infection Injury to pancreas Immune system disorder Type IINoninsulin- dependent diabetes mellitus (NIDDM) Adult-onset diabetes Insulin resistance and relative insulin shortage GestationalDiabetes during pregnancy Changes in body metabolism due to pregnancy 20-7

Type 1 Diabetes Mellitus Little or no insulin is produced by beta cells in the pancreas –Buildup of glucose in the blood –Body’s cells are starved for glucose Usually begins during childhood or young adulthood 20-8

Common Signs and Symptoms “Three polys” –Polyuria Increased urination –Polydipsia Increased thirst –Polyphagia Increased appetite Abdominal pain with vomiting Fruity breath odor Blurred vision Tiredness 20-9

Treatment Usually requires treatment with insulin Some patients also require treatment with oral medication 20-10

Type 2 Diabetes Mellitus Most common type of diabetes Usually affects people older than 40 years of age Caused by a combination of insulin resistance and relative insulin shortage 20-11

Type 2 Diabetes Mellitus Major causes of insulin resistance –Obesity –Genetics –Sedentary lifestyle –Stress 20-12

Gestational Diabetes Develops during pregnancy Treatment –Special diet –Regular, moderate exercise –Daily blood glucose testing 20-13

Complications of Diabetes Mellitus Changes in the retina that can lead to blindness Kidney damage Nerve damage –Can lead to loss of sensation and pain Circulatory disorders 20-14

Hypoglycemia Lower-than-normal blood sugar level –Less than 70 mg/dL in adults Most common diabetic emergency Symptom onset is sudden –Minutes to hours 20-15

Hypoglycemia Signs and Symptoms Early Sweating Palpitations Increased heart rate Tremors Pale color Hunger Headache Nervousness Late Confusion, irritability Tiredness Staggering walk Visual disturbances Cool, pale, clammy skin Fainting Seizures Coma 20-16

Hypoglycemia The blood sugar level may become too low if the diabetic patient: –Has taken too much insulin –Has not eaten enough food –Has overexercised and burned off sugar faster than normal –Experiences significant physical or emotional stress 20-17

Hyperglycemia Higher-than-normal blood sugar level Gradual onset –Hours to days 20-18

Hyperglycemia Signs and Symptoms Altered mental status Kussmaul respirations Sweet or fruity (acetone) breath odor Loss of appetite Thirst Dry skin Abdominal pain Nausea and/or vomiting Increased heart rate Normal or slightly decreased blood pressure Weakness 20-19

Diabetic Ketoacidosis (DKA) Severe, uncontrolled hyperglycemia –Usually over 300 mg/dL Usually occurs in people who have type 1 diabetes –May also occur in type 2 diabetes DKA is also called diabetic coma 20-20

Hyperglycemia The blood sugar level may become too high when the diabetic patient: –Has not taken his insulin or oral diabetic medication, or has taken an incorrect dose –Has eaten too much food that contains or produces sugar –Has lost a large amount of fluid, such as through vomiting –Experiences physical or emotional stress that affects the body’s insulin production 20-21

Patient Assessment Scene size-up Primary survey 20-22

Patient Assessment Establish patient priorities Determine the need for additional resources Make a transport decision 14-23

Patient Assessment Secondary survey –SAMPLE history –OPQRST –Physical exam Focused exam if patient responsive Rapid medical assessment if unresponsive 14-24

Emergency Care Stabilize the spine if trauma is suspected Assess need for oral or nasal airway Suction as necessary Give oxygen Remove or loosen tight clothing Maintain body temperature Perform a blood glucose test Give oral glucose per protocol if patient can swallow Transport Perform ongoing assessments 20-25

Performing a Blood Glucose Test Purpose Indications –Unresponsive patient, cause unknown (any age group, including trauma) –Known diabetic patient with signs and symptoms – Patients with altered mental status, cause unknown (including trauma) –Special situations 20-26

Performing a Blood Glucose Test 20-27

Performing a Blood Glucose Test [Insert skill drill 20-1 step 2]

Performing a Blood Glucose Test [Insert skill drill 20-1 step 3]

Performing a Blood Glucose Test [Insert skill drill 20-1 step 4]

Oral Glucose If approved by medical direction, you may give oral glucose to a patient who: –Has an altered mental status –Has a history of diabetes controlled by medication –Is able to swallow 20-31

Giving Oral Glucose [Insert skill drill 20-2 step 1]

Giving Oral Glucose [Insert skill drill 20-2 step 2]

Giving Oral Glucose [Insert skill drill 20-2 step 3]

Giving Oral Glucose [Insert skill drill 20-2 step 4]

Questions? 20-36